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RELEASE, WAIVER AND INDEMNIFICATION AGREEMENT

Next Level Management and Consulting, LLC

dba District Eat and Play

RELEASE, WAIVER AND INDEMNIFICATION AGREEMENT

Next Level Management and Consulting, LLC

DBA District Eat and Play

NOTICE TO THE MINOR CHILD'S NATURAL GUARDIAN

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF NEXT LEVEL MANAGEMENT AND CONSULTING, LLC DBA DISTRICT EAT AND PLAY THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM, YOU ARE GIVING UP YOUR CHILD'S RIGHT AND YOUR RIGHT TO RECOVER FROM NEXT LEVEL MANAGEMENT AND CONSULTING, LLC DBA DISTRICT EAT AND PLAY IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND NEXT LEVEL MANAGEMENT AND CONSULTING, LLC DBA DISTRICT EAT AND PLAY HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

I, myself, my heirs and personal representatives, hereby assume all liabilities, risks, injuries and hazards to my child/children, incidental to, or as a result of, participation in museum exhibits, climbing structure, ball pit, trampoline, inflatables, activities, and events and freely acknowledge the fact that this/these program(s) may have, and/or do involve, physical contact or other conditions or factual circumstances where physical or other injuries, including but not limited to concussion, may occur. As legal guardian and/or natural parent of the above referenced child/children, I do hereby waive, release and agree to indemnify and hold harmless Next Level Management and Consulting, LLC DBA District Eat and Play, their officers, agents, employees, the organizers, sponsors, activity supervisors, co-sponsoring organziations and participants for any claim, demand, liability, costs, suits, charges or compensation for loss or injury of any kind arising out of a loss or an injury, including losses or injuries arising from any inherent risks associated with the activities my minor child(ren) may be involved in while at Next Level Management and Consulting, LLC DBA District Eat and Play. I, as legal guardian and/or natural parent of the referenced child/children, assume all risk of injury, liability, and loss arising from my child/children's partcipation or presence at said activity. I acknowledge that Next Level Management and Consulting, LLC DBA District Eat and Play will not assume any costs relating to any injury while my child/children are involved in this activity. This Waiver, Release and Hold Harmless/Indemnification Agreement is in cosideration of Next Level Managment and Consulting, LLC DBA District Eat and Play permitting my child/children's participation in the activity or program at issue and in further consideration of Next Level Management and Consulting, LLC DBA District Eat and Play not requiring self-funded liability insurance coverage on my part as a condition precedent to my child/children's participation in the activity. I, as legal guardian and/or natural parent of the aforesaid child/children, freely and voluntarily assume all risk of loss or injury arising from my child/chilren's participation in the activity whether due to my negligence, my child/children's negligence or the negligence or intentional acts of others. I acknowledge that, absent this Release and indemnification, Next Level Management and Consulting, LLC DBA District Eat and Play, or other sponsors of the activity would not have offered me, or my child/children, the access to the activity because of unacceptable exposure to civil liability claims and/or lawsuits, or the expense of providing a program that is risk-free. By signing this waiver, I agree to indemnify any and all employees of Next Level Management and Consulting, LLC DBA District Eat and Play for any and all damages which result from any and all acts or omissions, including negligence, in whole or in part, on the part of any Next Level Management and Consulting, LLC DBA District Eat and Play employee. I have read and understood this document and sign it freely and knowingly, intending that it shall be fully operative and effective in all respects and that it waives legal rights to which I, or my child/children, might otherwise be entitled if my child/children are hurt or suffer loss during his/her/their participation in that activity. YOU MUST CAREFULLY READ THIS DOCUMENT BEFORE SIGNING IT. YOU ARE WAIVING OR RELEASING VALUABLE LEGAL RIGHTS. YOU ARE ADVISED TO SEEK THE ADVICE OF AN ATTORNEY IF YOU DO NOT FULLY UNDERSTAND THIS DOCUMENT.

Photo/Video Release - I give permission for my child's and my image, video, and audio to be used for promotional purposes.

I Agree to Follow all posted rules. If I do not, I may be asked to leave with no refund given.

 


First Guests Name

First Name*

Middle Name

Last Name*

Phone*
First Guests Date of Birth*
First Guests Signature*
Second Guests Name

First Name*

Middle Name

Last Name*

Phone*
Second Guests Date of Birth*
Third Guests Name

First Name*

Middle Name

Last Name*

Phone*
Third Guests Date of Birth*
Fourth Guests Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Guests Date of Birth*
Fifth Guests Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Guests Date of Birth*
Sixth Guests Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Guests Date of Birth*
Seventh Guests Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Guests Date of Birth*
Eighth Guests Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Guests Date of Birth*
Ninth Guests Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Guests Date of Birth*
Tenth Guests Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Guests Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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